Obsessive Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a mental disorder in which people feel burdened by unwanted thoughts or forced to repeat troublesome actions. Unwanted thoughts, called obsessions, often include unreasonable fear of dirt or germs. Another common obsession involves fear of losing control and hurting oneself or others. Patients usually feel a need to perform repeated actions, called compulsions, to prevent harmful events. Some wash their hands excessively to avoid infection from germs. Many check faucets or stoves repeatedly to be sure they are turned off. Still others may engage in counting rituals or excessive prayers.

Research has shown that the things people with OCD worry about are the same things that everyone worries about. The difference is that
people with OCD can't dismiss the thoughts as irrational. The fact that the worries don't away, rather they cause undue distress is a key feature of the disorder.

Most people have certain routines and habits they find comforting. For example, a person may like to get dressed or prepare meals in a certain way. But most people can change their routines when necessary. People with obsessive-compulsive disorder feel unable to change, even though they know that their obsessions and compulsions are unrealistic.

OBSESSIONS are:

Thoughts, impulses or images that are distressing and anxiety
provoking.

Intrusive and persistent.

Often personally repugnant and occur against one's
will.

COMPULSIONS are:

Conscious behaviors or rituals that are done to alleviate
the anxiety caused by the obsessions.

Carried out even though the person is aware that the behaviors
are senseless or excessive.

OCD can start at any age although it is
usually first seen in childhood, adolescence, or early adulthood. Although the disorder may be episodic, left untreated OCD
can escalate in severity over time.
OCD affects two to four percent of the population worldwide.
According to the National Institute of Mental Health, OCD affects
four million adult Americans.

Depression frequently occurs with OCD. Most of these say they
are depressed because the OCD is affecting their lives; this is called secondary depression.
However, many also suffer from bipolar disorder
(manic-depression) that may influence the severity of the OCD.
Gilles de la Tourette's Syndrome may be associated
with OCD. This is a disorder characterized by involuntary facial
or body movements or vocalizations. The most well known symptom
of Tourette's syndrome is copralalia, the shouting out of obscenities.

OCD and the Brain

OCD is thought to involve a problem in brain functioning. Many experts believe that obsessive-compulsive disorder involves an imbalance in serotonin, one of the brain's most important messenger chemicals. Doctors may treat the disorder with medicines that correct serotonin levels. People may also be helped by behavior therapy, which teaches patients ways to resist their unreasonable thoughts and actions.

Work has been done using PET (Positron Emission Tomography) scans to look at brain metabolic changes in people with OCD. Some specific brain regions have been identified which may mediate OCD, namely the caudate nucleus and orbitofrontal cortex. These areas have been found to be hyperactive in people with OCD as compared to people who do not have OCD. The orbitofrontal cortex is involved in evaluating perceptions and choosing appropriate responses. This is why the person with OCD may be plagued with doubt, because they are not processing their perceptions adequately. The orbitofrontal cortex is connected with the caudate nucleus and acts like the brain's automatic transmission, allowing a person to 'shift gears' from one response to another. In the person with OCD, this process often gets stuck, which is why people with OCD repeat the same behaviors over and over again.

Causes of OCD

OCD is thought to have a genetic component. Most people with OCD
can identify someone else in their family who has OCD, depression or other anxiety disorders. Studies with identical twins who have
been separated at birth and who have later developed
OCD suggest that OCD is a genetic disorder. It does seem that
it can skip generations and that the severity of the disorder
may be different even within a family. That is, someone who has
severe OCD will not necessarily have children who will also have severe OCD.

Other possible causes of OCD can be head injury, psychological trauma, or infection.
This is called secondary OCD. Childbirth may also trigger OCD
for the mother but it seems unclear whether this might be due
to the stress of the birth, physical trauma that may cause brief
periods of lack of oxygen to the brain, hormonal, or immunologic
factors. It is worth noting that
stress will almost inevitably worsen OCD. It is important for
people who have OCD to learn how to deal with stress in healthy
ways.

In summary, a person is probably born
with a genetic predisposition to having OCD, which is often dormant
until some stressful event occurs and triggers the OCD into an
active phase.

Assessing OCD

Because of the variety of symptoms, OCD is commonly misdiagnosed. There are many sad stories about people who have been wrongly diagnosed with schizophrenia,
autism, or attention deficit hyperactivity disorder. A thorough evaluation by a
specialist in OCD is essential to successful diagnosis and treatment.

OCD is best diagnosed by a psychiatrist or psychologist.
There are several self-tests for screening the presence of OCD used by clinicians.
Once a diagnosis of OCD is made, the severity of the disorder can be assessed by use of the Yale-Brown Obsessive Compulsive Scale (YBOCS).